The Implementation of Dynamic Appraisal of Situational Aggression Score at Emergency Department Triage

Amy D Costigan; Laurel C O'Connor; Christopher Slocum; Kimberly Barry; Maureen M Canellas; Alexandra M Sanseverino; Erin Proudman; Karen Plainte; Mathew Shatsky; Janell Forget; Martin A Reznek

doi:10.1016/j.annemergmed.2025.02.023

The Implementation of Dynamic Appraisal of Situational Aggression Score at Emergency Department Triage

Ann Emerg Med. 2025 Apr 1:S0196-0644(25)00118-0. doi: 10.1016/j.annemergmed.2025.02.023. Online ahead of print.

Affiliations

¹ Department of Emergency Medicine, University of Massachusetts Chan Medical School, Worcester, MA; UMass Memorial Health, Worcester, MA. Electronic address: amy.costigan@umassmemorial.org.
² Department of Emergency Medicine, University of Massachusetts Chan Medical School, Worcester, MA; UMass Memorial Health, Worcester, MA.
³ UMass Memorial Health, Worcester, MA.
⁴ College of Holy Cross, Worcester, MA.

PMID: 40172506
DOI: 10.1016/j.annemergmed.2025.02.023

Abstract

Study objective: Violence in health care settings is a growing threat to patients and clinicians. This study's objective was to describe the demographic distribution of the Dynamic Appraisal of Situational Aggression (DASA) score at emergency department (ED) triage, identifying patterns in score variability across different patient groups and exploring associations with demographic factors.

Methods: From January 11, 2023 to December 31, 2023, patients aged 18 years and older were assigned a DASA score during triage at 5 EDs as part of a systemwide strategy to mitigate increasing workplace violence. Scores were used to stratify patients into established risk categories of aggressive behavior (low, moderate, high, or imminent). Subjects' DASA scores and demographic characteristics were abstracted from the electronic health record. Findings were reported descriptively with 95% confidence intervals for counts and proportions.

Results: There were 192,947 ED encounters during the study period, of which 159,154 (80.3%) had a DASA score assigned at triage (mean age, 51.5 years; 53.5% women). The data set comprised 98,751 unique patients. Male sex, younger age, high-acuity Emergency Severity Index, and arrival with police, by ambulance, or by aircraft were most associated with a high-risk DASA score assignment.

Conclusion: The use of the DASA instrument score at ED triage was highly adopted by staff. The demographic makeup of patients with a high-risk DASA score was concordant with prior literature describing patients at risk for committing violence against health care workers. Further research should investigate the predictive value of triage DASA assessment for aggressive patient behavior.

Keywords: DASA; Dynamic Appraisal of Situational Aggression; Restraint; Workplace Violence.